This article relate an end study research for master 2 of social psychology. The study of ethnic discrimination has been the subject of much research in the education and recruitment sectors, but few have focused on the medical field. Discriminatory behavior is at the heart of the problems of inequality of access to care for patients with an immigrant background. Mediterranean syndrome refer to the cultural stereotypes inferred from immigrant patients en leading to different discriminatory behaviors on the part of caregivers. It mean that mediterranean syndrome is also a behavior of exaggeration of symptoms on the part of a patient, due to his origins and his culture, and which in fact reflects the subjectivity of the interpretation of pain. It would therefore be based on the implicit prejudices that health professionals have about these sub-Saharan populations. Frantz Fanon is the first person who highlight the presence of discrimination in the hospital environment with what he called at the time the North African syndrome in 1950’s. The question that then arises is to understand how these discriminations can emerge even when caregivers pose as disease experts, but this harmonization of care and diagnostic criteria do not take into account the patient as a whole.
Most of the research on the Mediterranean syndrome is carried out on the basis of non-structured or semi-structured interviews and observations with nursing staff. I will present five research with différents results. First, Carde (2006 ; 2007) carried out a survey of nursing staff in different hospitals. The results of his research showed that there was indeed a discriminatory character of immigrants on the part of health professionals, this discrimination is direct or indirect and is often caused by institutional dysfunctions (for example health insurance, which does not not include all residents in view of a repression of immigration, thus delegitimizing their right to care).
Loriol et al. (2010) also conducted a survey of nurses. In this study, the researchers noticed that there was no racist remarks in the speeches collected during the interviews but that during the observations, there were stereotypical beliefs which were actualized or not according to the behaviors of the patients immigrants. Then they raised the question of inter-colleague relations as a reinforcement of the in-group against the out-group and of work routines aimed at facilitating the standardization of explanations of care and support without taking into account the subjectivity of the patient. The caregivers then come to categorize their audience on the basis of social representations and ethnic criteria in the service of the work collective. This social aspect of work collectives shows that the passage from speech to action is more easily done insofar as they enter into a collective norm and that the user acting differently would be more easily rejected. In addition, they showed that the Mediterranean syndrome could be reinforced and legitimized by the “anthropological rudiments” taught to nursing students. Finally, in the synthesis by Guilfoyle, Kelly and St-Pierre-Hansen (2008) which reports the results of research in terms of public health and socio-demographic data, we can see that the inequality of treatment is visible according to certain types of care in Canada and the United States, in particular for surgery on certain cancers, cesarean sections or even certain screenings. Thus, discrimination and prejudice against immigrants are not found only in France and are in a way universal processes.
Finally, Nacu (2010), in her research on migrant women in maternity hospitals, underlines that the interviews carried out with the nursing staff made it possible to conclude that there was indeed discrimination due to stereotypes based on the culture of these immigrant patients. considered “more difficult” than their “White” friends. Nawroski (2017), who analyzed numerous consultations with doctors, also insists on the representations of doctors in consultations and indicates that there is always a part of beliefs in this caregiver / patient relationship and that it is to be taken into account, especially during treatment and prevention.
To resume the study research for master 2 of social psychology, a questionnaire as been created from the différents interviews based on précédents research and 98 caregivers respond. Today, this research made it possible to shed light that there was indeed a Mediterranean syndrome but that the caregivers more able to produce it were those who had never heard of it. In addition, those who had had prevention training on this form of discrimination were more able to counter it consciously. Information is therefore a key point for prevention and good patient care.
Key words : Prejudice, Stereotypes, Ethnic discrimination, Culture, Hospital environment, Mediterranean syndrome
Bibliography :
Carde, E. (2006). Les discriminations selon l’origine dans l’accès aux soins. Etude en France métropolitaine et en Guyane. Document de recherche en santé publique option sociologie.
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Fanon, F. (1952). Le syndrome nord-africain. Essai. https://esprit.presse.fr/article/frantz-fanon/le-syndrome-nord-africain-18214
Guilfoyle, J., Kelly, L., & St-Pierre-Hansen, N. (2008). Préjugés en médecine: Notre rôle dans les inégalités en matière de santé. Canadian Family Physician, 54(11), 1518–1520
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Nawroski, L. (2017). Les représentations dans le discours Médecin-patient de consultations filmées de Médecine Générale en matière de prévention et de dépistage : impact sur la relation de soin, la transmission et l’adhésion au message. Document de thèse de médecine générale. http://www.cmge-upmc.org/spip.php?article368
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